Sumayya P M
About Candidate
I am a CPC Certified Medical Coder with Over 2+ years of experience in Denial Management and Resubmission Processes. I hold a Bachelor’s degree in Biomedical Engineering.
Previously, I worked as a Denial Analyst at CCRCM, Burjeel Holdings, where I was responsible for analyzing and resolving insurance claim denials, reviewing payer requirements, preparing appeals, and ensuring compliance with healthcare regulations and insurance guidelines.
Throughout my professional experience, I have developed strong expertise in:
• Insurance claim processing and denial management.
• Claims resubmission and reconciliation activities.
• Medical coding compliance with DHA, HAAD, and payer guidelines.
• Root cause analysis of claim rejections and denials.
• Revenue cycle management and reimbursement optimization.
• Coordination with healthcare providers, coders, and insurance companies.
• Working with healthcare platforms such as Cerner, SAP, eClaim link, MyCare and BestCare.
• Maintaining accurate documentation and ensuring timely claim resolution.
Location
Education
Work & Experience
Certified professional coder with over 2+ years of experience as Resubmission officer/Denial Analyst. where I specialized in reviewing rejected claims from both medical and insurance perspectives. My role involves identifying the root causes of denials, verifying insurance eligibility through portals such as OpenJet, NAS, ADNIC, Nextcare, MetLife, Mednet, AXA, Sukoon and Neuron, and ensuring timely and accurate resubmission of claims with proper medical and technical justifications as per HAAD adjudication guidelines and managing the complete insurance workflow including patient eligibility verification, pre-authorizations, claim submission, follow-ups, reconciliation, and payment processing. Through this experience, I have developed strong expertise in ICD-10-CM, CPT, and HCPCS coding standards, denial code analysis, and revenue cycle management support. I consistently focus on accuracy, compliance, and improving reimbursement outcomes by minimizing repeat denials and strengthening documentation quality.
